간 , 담도 및 췌장 : 췌장암의 임상적 고찰

The diagnosis of pancreatic cancer is very difficult because the pancreas is located in the retroper- itoneum, symptoms are diverse, and physical findings are not specific. In the USA & western Europe, the incidence of pancreatic cancer has increased since 1930 and is the fourth most common cancer of all sites as a cause of death. Although recently, ERCP ultrasonogra phy (US) & computed tomography (CT) have been widely used for the diagnosis of pancreatic cancer is still difficult. The prognosis of pancreatic cancer is very poor because the retroperitoneal location of the cancer is unsuitable for diret palpation & the profuse lymphatics & venous drainage of the pancreas invite early & widespread dissemination of the tumor cells. In order to evaluate the incidence, epidemiology, clinical manifestations, laboratory findings & ERCP findings, the author analysed 91 cases of pancreatic cancer which were confirmed by surgery 8r ERCP at the Deparment of Internal Medicine, Hanyang University, College of Medicine between January 1972 & September 1986. The results were as follows 1) The pancreatic cancer was most prevalent in 6th & 7th decade (62.7%). Male to female ratio was 1.5:1, with male preponderance. 2) Epigastric pain was most common symptom complained (91%). Weight loss (88%), anorexia (61 %) & vomiting (42%) were also frequently noted in order of frequency. 3) The patient who had under 3 months duration of illness before confirmatory detection was found in 82.4% and those over 1 year duration in 4.4%. 4) The obstructive jaundice (23.1%) was the most common clinical impression of the patients followed by pancreatic cancer (16.4%), peptic ulcer disease (15.4%), pancreatitis (11%) & GB stone (5. Goyo). 5) In physical examination, hepatomegaly was palpable in 52% of patients. Jaundice (37%), abdominal mass (15%) & ascites (10%) were noted in order of frequency. 6) In laboratory findings, the elevated alkaline phophatase was most frequent in 79% of pathients. The elevated SGOT (62%), hyperbilirubinemia (55%) & anemia (32%) were frequently found in order of frequency. 7) In relation with diabetes mellitus, the patient of pancreatic cancer had the DM in 4%. The developmont of diabetes de novo is in 18%. 8) In the 91 patients who were diagnosed, the head of the pancreas was the most common site (68 %) of the tumor following by body (20%) & tail (12%). 9) Regional lymph node metastases were found in 57% & other metastaic sites were liver (53%), abdominal viscera (5